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SHELL OIL C 1f 11 <br /> COMPANY �� CHAIN OF CUSTODY RECORD Date: <br /> RETAIL. ENVIRONMENTAL ENGINEERING - WEST Sorial No: 7420 -- r_ I page J of <br /> 2 <br /> Silo Addrou: <br /> 2575 Countr Club Blvd. , Stockton, CA Analysis Required LAB: <br /> 1�JIC�: <br /> 204-7524-3505 CHOCK ONE(1)1, xONLY CT/Dr WINARO(1Na TIME <br /> Shell Enginoor. hono No.: 510 ` aw wwnlodnv ul;T <br /> Alex Perez <br /> �-2168 � v I a�heun ❑ <br /> 1SSIo Inrorripdb i ❑ 41I <br /> Corig3L� lgqnl Name & Address• fl �Iheua ❑ <br /> I3 Laine 'tech Services. Inc. t•�c1a..Iry/oyPorel ❑ 2 <br /> 1680 Rogers Ave. San Jose CA 95112 ltdeyoeHa�mep <br /> Con -&Q1 Conlact: _ x wd.r <br /> Phone No.; 408- cb.rry/capo.el ❑ 4413 <br /> Fran Thie 573-0555 In I- �� Olh.r ❑`� <br /> '^ N w •n O t Rom orsrr ❑ 4rfl <br /> Fax f!• 573-7771 0 n <br /> Commonls: t t� o N �I NON: I1o11lrlaber <br /> O wd.r R•rti or f <br /> `i 11 () ✓l Y} "O N `.. rY O a Al r� ❑ �S] soon al loa4lW of <br /> r <br /> O p 0 24/46 hrr. IAT J <br /> Sampled by: " M z Oih.r <br /> 4 ❑ <br /> �n N O G ti N II <br /> O Z <br /> Printed Name;L�� G.'/��., : a Q 4 0 o b M o UST AGENCY: <br /> "- °i ° c N <br /> No or c `" x E 'o ° MATERIAL SAMPLE <br /> Sample ID Dola sludge sots Woler Alr �_� <br /> cant: ,a �w u U Q V V DESCRIPTION CONDITION/ <br /> 121 -- II COMMENTS <br /> ---------------- <br /> Af JAI <br /> /fru nS � II <br /> -- II • <br /> .212E .2 II <br /> l w- <br /> II <br /> 17 <br /> II <br /> Rall d By Prinled Noma. <br /> 4 Date. Q Racghr0 slgnaluro} Pr lad Na ; <br /> Roll uI plod a ilmo �� u Dole: <br /> d B urv). 00 <br /> Prlltilud C. Dnle RacoNad(signature}, <br /> Time 3 Prinlud Nama: II e, <br /> Rollnqurshod ay(dpnalwr -) rdwed Name <br /> + DOIo 11 Rocplved�l luro} Prinldd Name. <br /> Win. � Out Gyr. �w Dula. <br />